Provider Demographics
NPI:1982694311
Name:LUTHERAN SENIOR CITY
Entity Type:Organization
Organization Name:LUTHERAN SENIOR CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-228-5200
Mailing Address - Street 1:935 N CASSADY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2283
Mailing Address - Country:US
Mailing Address - Phone:614-252-4987
Mailing Address - Fax:614-252-5952
Practice Address - Street 1:935 N CASSADY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2283
Practice Address - Country:US
Practice Address - Phone:614-252-4987
Practice Address - Fax:614-252-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4659314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0037114Medicaid
OH365499Medicare ID - Type Unspecified